Abstract Background Although highly effective, primary failure and loss of response to anti tumor necrosis factors (anti-TNF) alpha in inflammatory bowel disease (IBD) are common and associated with poor clinical outcomes. Multiple factors, including genetics, have been involved in the response to anti TNF alpha therapy. Thus, the purpose of our study was to evaluate the impact of the polymorphism of the SNPs rs1799724 (TNF alpha), rs767455 (TNFRSF1A), and rs1061622 (TNFRSF1B) in the response to anti-TNF alpha treatment in Tunisian IBD patients. Methods We conducted a prospective study including patients followed for IBD and treated with anti-TNF alpha. We classified these patients into two groups: responders and non-responders to anti-TNF alpha. Genomic DNA was purified from peripheral blood leucocytes using the salting-out method. Subjects were genotyped for polymorphisms TNF (rs 1799724), TNFRSF1A (rs767455) and TNFRSF1B (rs1061622) using a variant of allele-specific PCR, Mutagenically Separated PCR (MS-PCR). Genotypic and allelic frequencies were compared between the two groups of patients. Results We included 61 IBD patients with a mean age of 38,9 years [18-64 years]. Forty six patients (75.4%) had CD and 15 (24.6%) had UC. In the CD group, 35 (76.1%) patients were treated with infliximab and 11(23.9%) with Adalimumab. Nineteen were responders to treatment (41,3%) and 27 (58.7%) experienced treatment failure: primary failure in 4 and loss of response in 23. Genetic analysis did not show any association between the response to anti TNF alpha treatment and SNPs rs1799724 (TNF alpha) (P= 0,12 ; OR = 1,9) and rs1061622 (TNFRSF1B) (P= 0,9; OR= 1,06). Although, the CT genotype of rs767455 (TNFRSF1A) was associated with non-response (OR= 3.5 with a 95% CI [0.98-12.4], p=0.049). In the UC group, 14 patients were treated with Infliximab and only one patient treated with Adalimumab. Seven patients responded to anti-TNF therapy (46.7%) and 8 were non-responders (53.3%) with 5 cases of primary failure and 3 cases of loss of response. We didn’t find any association between the SNPs rs1799724 (TNF alpha), rs767455 (TNFRSF1A), and rs1061622 (TNFRSF1B) and response to anti TNF alpha in the UC patients. Conclusion Among the three SNPs studied, only the rs767455 (TNFRSF1A) was shown to be associated with non-response to anti-TNF in chrohn’s disease patients. However, our results need to be validated in a larger sample of patients.

Aims Acute Upper gastrointestinal bleeding (UGIB) is a common emergency in gastroenterology with significant morbidity and mortality. Many scores are used during the first assessment to provide an early and accurate stratification of the need of intervention, re-bleeding and mortality risk.

Aims Helicobacter Pylori-infected gastric mucosa shows distinct manifestations under upper gastrointestinal endoscopy. Chinese studies established a new scoring system based on the Kyoto classification score and proved its accuracy in diagnosing HP currect infection in the Chinese population. We aimed in this study to evaluate its performance in the Tunisian Population.

Aims Duodenal biopsies are routinely performed on all patients exhibiting symptoms suggestive of Celiac Disease (CD). The aim of our study is to evaluate the diagnostic yield of systematic duodenal biopsies in patients showing clinical manifestations suggestive of CD.

Aims All anticoagulant treatments, whether preventive or curative, maybe responsible for digestive hemorrhage (DH). These are essentially anti-vitamin K drugs (VKA), most often due to dosage errors. The management of these patients poses a major therapeutic problem, since the hemorrhage occurs in elderly patients at high thrombo-embolic risk, with the increased incidence of severity of these DH. The aim of this study was to clarify the epidemiological, clinical and evolutionary of DH in elderly patients with VKA overdosage.

Aims Gastric atrophy and intestinal metaplasia are precancerous lesions that can progress to gastric cancer. The progression of histological abnormalities induced by Helicobacter pylori (HP) towards these two lesions depends on certain factors related to the bacteria itself, the host, and environmental factors. The aim of this study is to evaluate the prevalence and factors associated with gastric atrophy and intestinal metaplasia in patients infected with HP.

Aims Helicobacter pylori (HP) is a bacteria that plays a central role in the development of various gastrointestinal conditions, including gastritis, which can progress to gastric or duodenal ulcers and gastric adenocarcinomas. The aim of our study is to investigate the epidemiological, endoscopic, and histological aspects of HP-associated gastritis.

Le syndrome de plummer vinson aussi appelé dysphagie sidéropénique est une entité très rare qui associe une triade : anémie ferriprive, dysphagie mécanique et diaphragme œsophagien supérieur. Son association avec la maladie cœliaque a été rarement rapportée. Nous rapportons une série de trois cas de syndrome de plummer-vinson dont l’anémie ferriprive est secondaire à une maladie cœliaque. Deux femmes âgées de 58 ans et une femme âgée de 45 ans ont été hospitalisées dans notre service pour prise en charge d’une dysphagie aux solides associée à une anémie hypochrome microcytaire ferriprive. Le diagnostic de syndrome de plummer vinson a été retenu devant l’aspect en faveur au transit oeso-gastro-duodénal montrant une sténose régulière centrée de l’œsophage cervical, avec à l’endoscopie digestive haute une sténose annulaire de la partie proximale de l’œsophage cervical n’admettant pas le fibroscope, les trois patientes ont bénéficié d’une dilatation d’un anneau de plummer vinson et la totalisation de l’endoscopie digestive haute a montré une raréfaction des plis duodénaux dont la biopsie a conclu à une duodénite lymphocytaire avec atrophie villositaire totale classée IIIC de Marsh. Le diagnostic de maladie coeliaque associé à un syndrome de plummer-vinson a été retenu, en plus de la dilatation endoscopique, les trois patientes ont été traitée efficacement par supplémentation en fer avec régime sans gluten. L’étiopathogénie du Plummer-Vinson est inconnue. Le facteur le plus vraisemblablement impliqué est la carence en fer. D’autres facteurs incluraient la malnutrition, une prédisposition génétique ou un processus autoimmunitaire. La maladie cœliaque, une cause classique de carence en fer par mécanisme de malabsorption, doit être considérée comme facteur étiologique de la dysphagie sidéropénique. Ceci met l’accent sur la nécessité de dépister la maladie cœliaque chez les patients atteints de syndrome de plummer-vinson.

Aims Appropriate use of colonoscopy is a key component of quality management in gastrointestinal endoscopy.

Aims The aim of this study was to explore the interobserver variation in the assessment of endoscopic lesions in Ulcerative colitis (UC) and to compare it with the UC endoscopic index of severity (UCEIS).

Aims Gastroesophageal reflux disease (GERD) represents a public health problem because of its prevalence and its impact on the quality of life of patients. Esophagitis represents one of its main complications. The aim of the work is to describe the epidemiological, clinical and endoscopic lesions of gastroesophageal reflux disease.

Introduction: The COVID-19 pandemic is having a major clinical and also organizational impact on national health care systems which has led to dramatically change in management of patients with chronic diseases such as inflammatory bowel disease. (IBD). The national lockdown, the social isolation, the fear of COVID-19 and the intolerance of uncertainty are likely to contribute to the developing or the exacerbation of symptoms of anxiety and depression. These symptoms are already reported to be prevalent among people with IBD and are associated with active disease, complications and relapses. Aims & Methods: This study aimed to explore both the clinical and psychological effects of the first wave of COVID-19 in Tunisia on patients with IBD. We included 110 patients followed in our unit for IBD. For each patient, we retrospectively determined the clinical, biological and endoscopic features preceding the pandemic outbreak in Tunisia (from March to Mai 2020) (P1) and compared them to the features noted during the next succeeding period (P2). Patients were then contacted by phone and they were asked to report data about their isolation context, the socioeconomic impact of the pandemic, contact with COVID-19, concerns, information-seeking behaviors, risk perception, medication and adherence. Results: Among the 110 patients included in the study, 50 were male (45.5%). The median age in our population was 40 years, interquartile range (IQR) [30-48]. Around sixty percent of our patients (n=68) had Crohn disease (CD). All patients included in the study stopped working during the national lockdown as none of them was an essential worker. Eleven patients (10%) stopped taking their medications after the first wave, 8 of which could not access the treatment and 3 were afraid of the drugs' possible side effects. HADS-A scores consistent with a diagnosis of anxiety were reported in 18,2% (n=20) of patients. No patients reported scores consistent with depression. Twenty percent of patients (n=22) experienced lack of sleep and excessive fear of contracting the COVID-19 infection and considered themselves at higher risk for severe COVID-19 infection than the general population. Based on a multiple logistic regression analysis, patients with anoperineal lesions were more likely to express anxiety (p:0.003). Patients who underwent surgery and those on immunosuppressive agents were more likely to perceive themselves as a high-risk profile (p: 0,035;0,01). Conclusion: The COVID-19 pandemic seems to be affecting both drugs accessibility and adherence. IBD health care professionals should be attentive of patients' psychological response to this pandemic and its possible effects on disease progression.

Aims Small polyps represent the majority of colorectal polyps detected in colonoscopy and they are considered to have low potential for malignant transformation. Given the low risk of advanced adenomas in this group, the « DETECT and LEAVE » strategy is usually discussed for diminutive polyps (≤ 5 mm) because of its high cost. The aim of this study is to determine the histopathological nature of resected diminutive colorectal polyps (≤ 5 mm) and to evaluate the necessity of a systematic histopathological assessment.

Malgré l'usage des anti-sécrétoires, la maladie ulcéreuse du bulbe compliquée de sténose demeure une situation non exceptionnelle dans notre pays. L'objectif de notre étude était d'évaluer les facteurs prédictifs de recours à la chirurgie au cours des ulcères sténosants du bulbe. Les dossiers de patients pris en charge pour ulcère sténosant du bulbe ont été colligés entre 2015 et 2020. Les facteurs prédictifs de chirurgie ont été évalués. Nous avons inclus 31 patients d'âge moyen 55,4 ans. Il s'agissait de 20 (64,5 %) hommes et1 (35,5 %) femmes. La durée d'évolution des symptômes était variable de 1 à 60 mois. Le taux de réponse à un traitement par IPP était 54,8 %. Une dilatation endoscopique a été proposé chez 6 (19,4 %) patients et un traitement chirurgical chez 8 (25,8 %) patients. Le geste réalisé était une gastro-entéro-anastomose (GEA) chez 3 (9,7 %) patients et une antrectomie avec anastomose gastrojéjunale chez 5 (16,1 %). Les facteurs prédictifs de chirurgie étaient la durée d'évolution des symptômes (34 ± 19,9 mois vs. 9,7 ± 8,3 mois ; p = 0,01), l'amaigrissement (41,2 % vs. 7,1 % ; p = 0,04), l'anémie (50 % vs. 5,9 % ; p = 0,01), l'hypoalbuminémie (34,9 ± 4,1 g/L vs. 38,5 ± 3,8 g/L ; p = 0,02) et l'insuffisance rénale (43,8 % vs. 6,7 % ; p < 0,03). L'âge, le genre et le tabac n'étaient pas identifiés comme facteurs pronostiques dans notre étude. Un traitement chirurgical était nécessaire chez un quart de nos patients. L'ancienneté d'évolution des symptômes, l'amaigrissement, l'anémie, l'hypoalbuminémie et l'insuffisance rénale seraient des facteurs prédictifs de recours à la chirurgie au cours des sténoses ulcéreuses du bulbe.

Aims Pneumatic dilation (PD) is considered the first line therapy for achalasia. The aim of our work is to evaluate the efficiency of this procedure and to establish the predictive factors of its failure.

Abstract Background Perianal manifestations of Crohn’s disease considerably affects the life quality of patients. This study aims to assess the quality of life of patients with perineal Crohn’s disease by using the SIBDQ (Short Inflammatory Bowel Disease Questionnaire) and to evaluate its correlation with the Perineal Disease Activity Index (PDAI). Methods We retrospectively reviewed the medical records of patients with perineal Crohn’s disease between January 2018 and December 2020. Patients with active luminal disease were not included in this study (Crohn’s Disease Activity Index (CDAI) > 150). All participants answered the SIBDQ. Active perineal disease was defined as a PDAI > 7. We studied the correlation between SIBDQ and PDAI. Patients were divided into 2 groups according to the duration of the disease greater or less than 5 years. SIBDQ and PDAI were compared between the 2 groups. Results We included 52 patients with a mean age of 37 years (range: 17–62 years). There were 34 males (65.4%) and 18 females (34.6%). Crohn’s disease has been diagnosed for 7.6 years in average (range 2–19 years). The PDAI varied from 1 to 15 (average=7) and the SIBDQ ranged from 11 to 66 (average= 41). The SIBDQ was inversely correlated to the PDAI with a Pearson’s correlation coefficient equal to -0.885 (p=0.01). Indeed, the SIBDQ score for patients with an active perineal disease was significantly lower than those with inactive one (28.3 ± 11.6 vs. 50.1 ± 7.7; p< 0.0001), which indicates a worse life quality. Comparing the 2 groups, there were no significant differences in terms of age, gender and PDAI. The SIBDQ was lower in patients who had the disease for more than 5 years compared to the other ones (38.3 ±15.6 vs.48.2 ± 7.5; p=0.003). Conclusion The quality of life for patients with perineal Crohn’s disease seems to be altered by both activeness and duration of the disease. The SIBDQ is a simple tool that helps physicians detect patients with poor life quality. Other studies are necessary to validate this questionnaire for the evaluation of the quality of life in patients with perineal Crohn’s disease.

Aims The treatment of distal diminutive polyps less than 5 mm in size remains a global challenge for endoscopists. The aim of our study was to evaluate the feasibility of “detect-and-leave “strategy by investigating the prevalence of advanced histological signs in diminutive polyps of the recto-sigmoid.

Aims Polyp size ≥1 cm triggers more frequent colonoscopic surveillance, yet size is typically based on subjective endoscopic estimates. The aim of this study was to compare contemporary assessments of polyp size by endoscopic estimation and pathology measurement.

Aims Microscopic colitis(MC),which is comprised of lymphocytic colitis and collagenous colitis,is a clinicopathological diagnosis that is commonly encountered in clinical practice during the evaluation and management of chronic diarrhea.It is currently recognized as a relatively common cause of diarrhea that is as common as inflammatory bowel disease.

Citation: Moalla M., et al. “Do Non-Invasive Markers of Fibrosis have a Place in the Evaluation of Fibrosis in Overlap Syndrome?”. EC Gastroenterology and Digestive System 7.2 (2020): 01-04. Abstract Introduction: The non-invasive markers of fibrosis are currently validated in viral hepatopathies but less validated in other dysimmune liver diseases. Very few studies have focused on the place of non-invasive markers of fibrosis in the overlap syndrome. The aim of our study is to determine the correlation between non-invasive markers of fibrosis and histological fibrosis scores in overlap syndrome. Methods: We conducted a retrospective study that collected all patients with an overlap syndrome: primary biliary cholangitis autoimmune hepatitis or primary sclerosing cholangitis autoimmune hepatitis. The APRI and FIB-4 scores were calculated at the time of diagnosis and one year after treatment. A liver biopsy specifying the degree of fibrosis according to Metavir was performed at the time of diagnosis. Liver elastography was done after one year of treatment. Fibrosis was considered significant from F2 for hepatic elastography and Metavir score and a cut-off > 1.5 and > 3.25 for APRI and FIB-4, respectively. The Spearman correlation test and the ROC curve were used to analyze the data. Results: Our study involved 56 patients divided into 52 women and 4 men of average age 51.1 years (30 73 years). Autoimmune hepatitis was associated with primary biliary cholangitis in 89.3% of cases and primary sclerosing cholangitis in 10.7% of cases. Spearman’s correlation analysis did not show a correlation between serum markers measured at the time of diagnosis and the degree of histological fibrosis (r = 0.5, p = 0.001). Among the 52 patients who would have significant fibrosis according to the APRI score, 20 patients had no significant histological fibrosis (F0, F1). Among the 48 patients who would have significant fibrosis according to the FIB-4 score, 30 actually had significant fibrosis (> = F2). After one year of treatment, 54 patients underwent hepatic elastography, which showed significant fibrosis in 70.3% of cases (38 patients). Correlation analysis did not show any correlation between serum markers of fibrosis and hepatic elastography. Among the 38 patients with significant fibrosis according to the measurement of hepatic elastography, 16 patients and 12 others were presumed to have no significant fibrosis according to the APRI and FIB-4 scores, respectively. Conclusion: In our study, we did not find any correlation between the different non-invasive markers of fibrosis and the results of the liver biopsy, which remains to this day the gold standard for assessing liver fibrosis in dysimmunitary disorders like overlap syndrome.